Abstract
Background
Neuroimaging is often unavailable in low-income countries, creating challenges for
precise diagnosis of neurologic disease in individual patients, and impeding acquisition
of precise neuroepidemiologic data for program and policy development.
Methods
We analyzed reports from 3614 head CTs performed between July 2013 and January 2016
at Hôpital Universitaire de Mirebalais, a public academic hospital in rural Haiti,
extracting patients' age, study indication, and radiologic findings.
Results
The most common indications for head CT were headache (27%), trauma (19.9%), abnormal
neurological exam (12.2%), and stroke (11.3%). The most common categories of neurologic
abnormalities were traumatic (31%), vascular (25.8%), and infectious (12%). Of 291
strokes, 64% were ischemic (median age at diagnosis 60.8 years, SD 17.4) and 36% were hemorrhagic (median age 52.0, SD 15.5). In patients undergoing
head CT for seizures or epilepsy, 17.5% had evidence of neurocysticercosis. In patients
with head trauma, 42.6% had intracranial hemorrhage or fracture. Atrophy was noted
on 10% of CTs (median age 57.1; SD 23.8), and was characterized as out of proportion
to age in 2% (median age 34.1, SD 15.3).
Conclusions
Median age of stroke patients in this rural low-income population is lower than in
high-income countries and proportion of stroke due to intracerebral hemorrhage is
higher. Neurocysticercosis is present in nearly one fifth of patients with seizures/epilepsy.
These findings can inform policies and programs for prevention and treatment of neurologic
disease in low-income settings.
Keywords
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Article info
Publication history
Published online: June 20, 2017
Accepted:
June 19,
2017
Received:
May 23,
2017
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
